National Health Service (NHS) England has removed wrong-site tooth extractions from its list of “Never Events.”
NHS England defines Never Events as incidents with “the potential to cause serious patient harm or death” that are “wholly preventable where guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and have been implemented by healthcare providers.”
The change will come into effect on April 1, 2021, but it has been confirmed in the latest revisions to the Never Events list.
The amendment to the list was recommended by an interdisciplinary, multi-stakeholder working group convened by NHS Improvement, whose review found that the barriers available and in place to prevent occurrences of wrong-site tooth extraction are insufficient to meet the Never Event definition.
The Healthcare Safety Investigation Branch also recommended the removal of wrong-site tooth extractions from the list of Never Events in its recently published National Learning Report on Investigations into Never Events, which details 10 incident types across healthcare, including wrong-site dental extractions, which the branch says do not meet the definition.
While this change means there are no longer any dentistry-specific mishaps classified as Never Events by the NHS, incidents of wrong-site extraction are still classified as Patient Safety Incidents and should continue to be reported and managed accordingly.
The Faculty of General Dental Practice (FGDP) UK said that it welcomes the removal of wrong-site tooth extraction from NHS England’s list of Never Events.
“I’m delighted that NHS England has acted swiftly to accept the recommendation that wrong-site extraction should no longer be classified as a Never Event,” said former FGDP(UK) dean Mick Horton, who represented the FGDP(UK) on NHS Improvement’s working group.
Horton also was among those who developed the NHS Local Safety Standard for Invasive Procedures (LocSSIPs) toolkit
“However, it remains vitally important to report and manage any instances as Patient Safety incidents, and I would urge dental teams and practice managers to download and digest the LocSSIPs toolkit in order to minimize the risk of wrong-site extraction happening in their practice,” said Horton.